| Values |
| Female |
| Male |
| prefer not to disclose |
| X |
| Field Name | Data Type | Value |
| Program | Dropdown | Behavior Health |
| Professions | Dropdown | Social Work |
| Social Worker Associate Independent Clinical License | Checkbox | True |
| Field Name | Data Type |
| Street | Text |
| City | Text |
| Country | Dropdown |
| State | Dropdown |
| Zip Code | Text |
| County | Text |
| Field Name | Data Type |
| Phone Number | Phone |
| Cell Number | Phone |
| Email Address |
| Field Name |
| Middle Name |
| First Name |
| Last Name |
| Date of Birth (mm/dd/yyyy) |
| Social Security Number |
| Gender |
| Field Name | Data Type | Value |
| Country | Dropdown | United States |
| Field Name | Data Type |
| State | Dropdown |
| Field Name |
| County |
| Field Name | Data Type | Value |
| Zip Code | Text | 12346789 |
| Error Message |
| Invalid ZipCode Format |
| Field Name | Data Type | Value |
| Country | Dropdown | Canada |
| Field Name | Data Type |
| State | Dropdown |
| Field Name | Data Type | Value |
| Zip Code Canada | Text | 12345 |
| Error Message |
| Invalid ZipCode Format |
| Field Name | Data Type | Value |
| Country | Dropdown | Afghanistan |
| Field Name | Data Type |
| State | Text |
| Field Name |
| County |
| Field Name |
| Alternate Names: |
| Field Name | Data Type | Value |
| Alternate Names: | Text | Auto |
| Field Name | Data Type |
| Street | Text |
| City | Text |
| Country | Dropdown |
| State | Dropdown |
| Zip Code | Text |
| County | Text |
| Field Name | Data Type |
| Street | Text |
| City | Text |
| Country | Dropdown |
| State | Dropdown |
| Zip Code | Text |
| County | Text |
| Field Name | Data Type | Value |
| Country | Dropdown | United States |
| Field Name | Data Type |
| State | Dropdown |
| Field Name | Data Type | Value |
| Zip Code | Text | 123456789 |
| Error Message |
| Invalid ZipCode Format |
| Field Name | Data Type | Value |
| Zip Code | Text | 12345 |
| Field Name | Data Type | Value |
| Country | Dropdown | Canada |
| Field Name | Data Type |
| State | Dropdown |
| Field Name | Data Type | Value |
| Zip Code Canada | Text | 12345 |
| Error Message |
| Invalid ZipCode Format |
| Field Name | Data Type | Value |
| Zip Code Canada | Text | 123456789 |
| Field Name | Data Type | Value |
| Country | Dropdown | Afghanistan |
| Field Name | Data Type |
| State | Text |
| Error Message |
| Error: 1. Do you have a medical condition which in any way impairs or limits your ability to practice your profession with reasonable skill and safety? is required. |
| Error: 2. Do you currently use chemical substance(s) in any way which impair or limit your ability to practice your profession with reasonable skill and safety? is required. |
| Error: 3. Have you ever been diagnosed with, or treated for, pedophilia, exhibitionism, voyeurism or frotteurism? is required. |
| Error: 4. Are you currently engaged in the illegal use of controlled substances? is required. |
| Error: 5. Have you ever been convicted, entered a plea of guilty, no contest, or a similar plea, or had prosecution or a sentence deferred or suspended as an adult or juvenile in any state or jurisdiction? is required. |
| Error: 6a. Possessed, used, prescribed for use, or distributed Controlled Substances or Legend drugs in any way other than for legitimate or therapeutic purposes? is required. |
| Error: 6b. Diverted controlled substances or legend drugs? is required. |
| Error: 6c. Violated any drug law? is required. |
| Error: 6d. Prescribed controlled substances for yourself? is required. |
| Error: 7. Have you ever been found in any proceeding to have violated any state or federal law or rule regulating the practice of a healthcare profession? is required. |
| Error: 8. Have you ever had any license, certificate, registration or other privilege to practice a healthcare profession denied, revoked, suspended, or restricted by a state, federal, or foreign authority? is required. |
| Error: 9. Have you ever surrendered a credential like those listed in number 8, in connection with or to avoid action by a state, federal, or foreign authority? is required. |
| Error: 10. Have you ever been named in any civil suit or suffered any civil judgement for incompetence, negligence, or malpractice in connection with the practice of the healthcare profession? is required. |
| Error: 11. Have you ever been disqualified from working with vulnerable persons by the Department of Social and Health Services (DSHS)? is required. |
| Field Name | Data Type | Value |
| 1a. Please explain medical condition. | Textarea | Test Medical Condition |
| 1b. Please explain how your treatment has reduced or eliminated the limitations caused by your medical condition. | Textarea | Test Limitations |
| 1c. Please explain how your field of practice, the setting or manner of practice has reduced or eliminated the limitations caused by your medical condition. | Textarea | Test limitations caused by your medical condition |
| Field Name | Data Type | Value |
| 2a. Chemical Substance Explanation | Textarea | Test Chemical Substance |
| Field Name | Data Type | Value |
| 3a. Diagnosis Explanation | Textarea | Test Diagnosis Explanation |
| Field Name | Data Type | Value |
| 4a. Controlled Substances Explanation | Textarea | Test illegal issue |
| Field Name | Data Type | Value |
| 5a. Conviction Explanation | Textarea | Test Conviction Explanation |
| Field Name | Data Type | Value |
| 6a. Controlled Substance Legal Explanation | Textarea | Test Controlled Substances Explanation |
| Field Name | Data Type | Value |
| 6b. Criminal Proceedings Explanation | Textarea | Test Criminal Proceedings |
| Field Name | Data Type | Value |
| 6c. Drug Law Violations Explanation | Textarea | Test Drug Law |
| Field Name | Data Type | Value |
| 6d. Self Prescribed Controlled Substance Explanation | Textarea | Test Self Prescribed |
| Field Name | Data Type | Value |
| 7a. Violation of State or Federal Law Explanation | Textarea | Test Violation of state |
| Field Name | Data Type | Value |
| 8a. License, Certificate, Registration Issue Explanation | Textarea | Test License Certificate |
| Field Name | Data Type | Value |
| 9a. Surrender Explanation | Textarea | Test surreender explanation |
| Field Name | Data Type | Value |
| 10a. Civil Judgement Explanation | Textarea | Test Civil Judgement |
| Field Name | Data Type | Value |
| 11a. Vulnerable Persons Disqualification Explanation | Textarea | Test 11Vulnerable persons |
| Field Name | Data Type | Value |
| 1. Enter your National Provider Identifier (NPI) Number if available. | Text | 123456 |
| Error Message |
| NPI is 10 digits. |
| Field Name | Data Type | Value |
| 1. Enter your National Provider Identifier (NPI) Number if available. | Text | 1234567890 |
| Error Message |
| NPI is 10 digits. |
| Link |
| Add |
| Error Message |
| Please add at least one other license, certificate or registration |
| Link |
| Add |
| Error Message |
| Country is required. |
| Credential Type is required. |
| Profession is required. |
| Credential Type is required. |
| Credential Number is required. |
| Issue Date is required. |
| Expiration Date is required. |
| Is this credential currently in an active status? is required. |
| How did you receive this credential? is required. |
| Field Name | Data Type | Value |
| How did you receive this credential? | Dropdown | Grandparented |
| Country | Dropdown | United States |
| State or Province | Dropdown | Alabama |
| Profession | Text | Test Doctor |
| Credential Type | Dropdown | Temporary |
| Credential Number | Text | 12345678 |
| Issue Date | Date | Today - 100 |
| Expiration Date | Date | Today - 0 |
| Field Name | Data Type | Value |
| Credential Number | Text | 23456789 |
| Field Name | Value |
| Credential Number | 23456789 |
| Error Message |
| Please add at least one. |
| Field Name | Data Type | Value |
| Country | Dropdown | United States |
| State or Province | Dropdown | Alabama |
| City | Text | test city |
| School or Training Program Name | Text | test School |
| School Type | Dropdown | College/University |
| Date From | Date | Today - 100 |
| Date To | Date | Today - 0 |
| Type of Degree | Text | Test Type of Degree |
| Attendance Status | Dropdown | Graduated |
| Field Name |
| Graduation Date |
| Field Name | Data Type | Value |
| Attendance Status | Dropdown | Attending |
| Field Name |
| Graduation Date |
| Link |
| Edit |
| Delete |
| Field Name | Data Type | Value |
| I declare that I’m working toward licensure as a Social Worker Advanced or Social Worker Independent Clinical. | Checkbox | true |
| Text |
| Are you the spouse or registered domestic partner of military personnel? |
| Other License, Certifications or Registrations |
| Text |
| Official Transcripts |
| Approved Supervisor Verification |
| Additional Information |
| Error Message |
| Please check the checkbox. |
| Field Name | Data Type | Value |
| I agree. | Checkbox | true |
| Field Name | Values |
| Dated: | Today - 0 |
| Initials: | AT |
| Field Name |
| 1. Do you have a medical condition which in any way impairs or limits your ability to practice your profession with reasonable skill and safety? |
| 2. Do you currently use chemical substance(s) in any way which impair or limit your ability to practice your profession with reasonable skill and safety? |
| 3. Have you ever been diagnosed with, or treated for, pedophilia, exhibitionism, voyeurism or frotteurism? |
| 4. Are you currently engaged in the illegal use of controlled substances? |
| 5. Have you ever been convicted, entered a plea of guilty, no contest, or a similar plea, or had prosecution or a sentence deferred or suspended as an adult or juvenile in any state or jurisdiction? |
| 6a. Possessed, used, prescribed for use, or distributed Controlled Substances or Legend drugs in any way other than for legitimate or therapeutic purposes? |
| 6b. Diverted controlled substances or legend drugs? |
| 6c. Violated any drug law? |
| 6d. Prescribed controlled substances for yourself? |
| 7. Have you ever been found in any proceeding to have violated any state or federal law or rule regulating the practice of a healthcare profession? |
| 8. Have you ever had any license, certificate, registration or other privilege to practice a healthcare profession denied, revoked, suspended, or restricted by a state, federal, or foreign authority? |
| 9. Have you ever surrendered a credential like those listed in number 8, in connection with or to avoid action by a state, federal, or foreign authority? |
| 10. Have you ever been named in any civil suit or suffered any civil judgement for incompetence, negligence, or malpractice in connection with the practice of the healthcare profession? |
| 11. Have you ever been disqualified from working with vulnerable persons by the Department of Social and Health Services (DSHS)? |
| 1. Enter your National Provider Identifier (NPI) Number if available. |
| Are you the spouse or registered domestic partner of military personnel? |
| Country |
| State or Province |
| Profession |
| Credential Type |
| Credential Number |
| Issue Date |
| Expiration Date |
| Is this credential currently in an active status? |
| How did you receive this credential? |
| Country |
| State or Province |
| City |
| School or Training Program Name |
| School Type |
| Date From |
| Date To |
| Type of Degree |
| Attendance Status |
| Field Name |
| First Name |
| Last Name |
| Date of Birth (mm/dd/yyyy) |
| Social Security Number |
| Gender |
| Street |
| City |
| Country |
| Zip Code |
| County |
| Phone Number |
| Cell Number |
| Email Address |
| Expiration Date |
| Issue Date |
| Text |
| There is a $2.50 convenience fee required to use the online service when paying by credit card/debit card. The amount will be charged in addition to your fee(s). There is no additional convenience fee for ACH payments. |
| Fees submitted with applications for initial credentialing, examinations, renewal and other fees associated with the licensing and regulation of the profession are nonrefundable. |
| Link |
| WAC 246-12-340. |
| Field Name |
| First Name |
| Last Name |
| Date of Birth (mm/dd/yyyy) |
| Social Security Number |
| Gender |
| Street |
| City |
| Country |
| Zip Code |
| County |
| Phone Number |
| Cell Number |
| Email Address |
| 1. Do you have a medical condition which in any way impairs or limits your ability to practice your profession with reasonable skill and safety? |
| 1a. Please explain medical condition. |
| 1b. Please explain how your treatment has reduced or eliminated the limitations caused by your medical condition. |
| 1c. Please explain how your field of practice, the setting or manner of practice has reduced or eliminated the limitations caused by your medical condition. |
| 2. Do you currently use chemical substance(s) in any way which impair or limit your ability to practice your profession with reasonable skill and safety? |
| 2a. Chemical Substance Explanation |
| 3. Have you ever been diagnosed with, or treated for, pedophilia, exhibitionism, voyeurism or frotteurism? |
| 3a. Diagnosis Explanation |
| 4. Are you currently engaged in the illegal use of controlled substances? |
| 4a. Controlled Substances Explanation |
| 5. Have you ever been convicted, entered a plea of guilty, no contest, or a similar plea, or had prosecution or a sentence deferred or suspended as an adult or juvenile in any state or jurisdiction? |
| 5a. Conviction Explanation |
| 6a. Possessed, used, prescribed for use, or distributed Controlled Substances or Legend drugs in any way other than for legitimate or therapeutic purposes? |
| 6a. Controlled Substance Legal Explanation |
| 6b. Diverted controlled substances or legend drugs? |
| 6b. Criminal Proceedings Explanation |
| 6c. Violated any drug law? |
| 6d. Prescribed controlled substances for yourself? |
| 6d. Self Prescribed Controlled Substance Explanation |
| 7. Have you ever been found in any proceeding to have violated any state or federal law or rule regulating the practice of a healthcare profession? |
| 7a. Violation of State or Federal Law Explanation |
| 8. Have you ever had any license, certificate, registration or other privilege to practice a healthcare profession denied, revoked, suspended, or restricted by a state, federal, or foreign authority? |
| 8a. License, Certificate, Registration Issue Explanation |
| 9. Have you ever surrendered a credential like those listed in number 8, in connection with or to avoid action by a state, federal, or foreign authority? |
| 9a. Surrender Explanation |
| 10. Have you ever been named in any civil suit or suffered any civil judgement for incompetence, negligence, or malpractice in connection with the practice of the healthcare profession? |
| 10a. Civil Judgement Explanation |
| 1. Enter your National Provider Identifier (NPI) Number if available. |
| Are you the spouse or registered domestic partner of military personnel? |
| State or Province |
| Profession |
| Credential Type |
| Credential Number |
| Issue Date |
| Expiration Date |
| Is this credential currently in an active status? |
| How did you receive this credential? |
| Timestamp | TestName | Status |
|---|---|---|
| Oct 26, 2022 05:29:49 PM | Validating the Intake Flow of Social Worker Associate Advanced and Independent Clinical License Application Intake.4.Validate the flow of Social Worker Associate Advanced and Independent Clinical License Application Intake flow - Social Worker Associate Independent Clinical License | pass |
| Name | Value |
|---|---|
| User Name | prince.gupta_mtxb2b |
| Time Zone | Asia/Calcutta |
| Machine | Windows 10 - 64 Bit |
| Selenium | 3.7.0 |
| Maven | 3.6.3 |
| Java Version | 1.8.0_151 |
| Name | Passed | Failed | Others | Passed % |
|---|---|---|---|---|
| @SocialWorkerAssociateAdvancedAndIndependentClinical1 | 1 | 0 | 0 | 100% |